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What are 4 key things to remember with kids with pneumonia?
- 1) recurrent may mean immunocompromised or mucociliary escalator problems
- 2) asplenia leads to pneumococcal disease
- 3) infants with GERD or TE defects may get aspiration pneumonia
- 4) right sided focal lesion in toddler: think foreign body
What do you look at on a CXR where you think they have pneumonia?
- 1) interstitial infiltrates
- 2) Consolidation
- 3) Pneumatoceles (cavity-like area)
- 4) Pleural effusion
What is the most common type of pneumonia in school aged kids, specific clinical signs.
- 1) Mycoplasma pneumoniae
- 2) most finding are unilateral and in the lower lobe
- 3) cold agglutinins after one week (IgM clumps in the blood at 4 degrees C)
- 4) treat with *mycin drugs for 2 weeks
What does co-oximetry measure and calculate?
- Measures: OxyHb, COHb, MetHb, Total Hb
- calculates: HHB (deoxy Hb)
What are some complications of obtaining arterial blood gasses?
- 1) pain
- 2) bruising/hematoma
- 3) nerve damage (radial nerve is close)
- 4) Thrombosis
- 5) sepsis
What causes hypoxemia?
- 1) low inhaled O2 partial pressure
- 2) reduced alveolar ventilation
- 3) impaired diffusion
- 4) V/Q mismatch
- 5) Shunt
What are the CO2 levels or HCO3- levels you think you would see in metabolic and respiratory alkalosis and acidosis?
- metabolic acidosis: decreased HCO3-
- metabolic alkalosis: increased HCO3-
- respiratory acidosis: increased PaCO2
- respiratory alkalosis: decreased PaCO2
- disorder of the airways characterized by:
- -paroxysmal (sudden recurrence) persistent symptoms
- -variable obstruction
- -hyperresponsiveness due to a number of stimulii
How would you asses asthma severity?
- 1) Sx
- 2) FEV1
- 3) Morbidity
- 4) beta 2 requirements
Describe ideal asthma control
- -Symptoms <= 3 times a week, none at night
- -rescue beta use (same as above)
- -normal lifestyle
- -no morbidities (missing work/school, etc)
- -FEV1 >90% of personal best
What are the 4 main medications used in asthma control and what do they do?
- 1) bronchodilators
- -beta 2 agonists (short acting)
- -long acting beta 2 agonists (LABA)
- 2) anti inflammatories
- -LTRA (leukotriene receptor antagonist)
What are three things that should come to mind if asthma therapy isn't helping a patient?
- 1) non-compliance
- 2) Not (only) asthma
- 3) Severe asthma
What are the 6 facets of asthma exacerbation managment?
- 1) asses
- 2) Cause
- 3) Asthma Rx
- 4) Supportive Rx
- 5) monitor for complications
- 6) follow up (give them a written action plan)
Define FVC, VC, FEV1
- FVC - forced exhalation from maximal inspiration
- VC - slow exhalation from maximal inspiration
- FEV1 - forced exhalation from max inspiration in the first second
PFT parameters are standardized to what? Which of these lack good standardization data?
- (race is important too)
- lack good standardization values for extremes of age.
What are 2 big factors that affect FRC?
- anaesthesia reduces FRC
- obesity reduces FRC
2 big factors that affect VC and TLC
increased compliance (emphysema) increases VC and TLC
increased elastance (fibrosis) decreases VC and TLC
What does a high or low FEV1/FVC mean? What limit is characteristic of asthma or COPD?
- high: restriction
- low: obstruction
Ratio of < 0.7 is diagnostic of these obstructive diseases
What is Cystic Fibrosis?
- -autosomal recessive mutation of Cl- channel proteins
- -multisystem: lung, panc, liver, GI/nutrition, bones, sleep, reproductive)
Definition of pulm HTN and the five classification categories
- >25 mm Hg (normal is 15)
- 1) arterial pulm HTN
- 2) increased venous pressure due to left heart disease
- 3) hypoxic vasoconstrict due chronic lung disease
- 4) chronic thromboembolitic disease
- 5) unknown etiology
What are some clues that someone has CF (5)
- -congenital absence of the vas deferens
- -malabsorption and steatorrhea
- -meconium ileus
- -electrolye ELEVATION in the SWEAT (opposite of how it works in the lungs)
- -Chronic cough
4 signs of pulmonary HTN
- -loud, palpable P2
- -HV heave
- -Right sided S4
- -tricuspid regurg
How would you conventionally treat CF? (4)
- 1) clearance of lower airways (physio, mechanical, forced expiration)
- 2) Treat resp infections
- 3) replace pancreatic enzymes
- 4) reverse secondary nutritional and vitamin deficiencies
What is the most detrimental factor to growth in kids?
What are 5 causes of ICS failure in chronic cough in kids?
- 1) Low compliance
- 2) Dosage is too low: start high and go low
- 3) Method of administration is inappropriate
- 4) Comorbidities: persistent allergen exposure, aspiration/GERD, sinusitis
- 5) purulent airways (CF, bronchiectasis, etc)
What is a critical factor you can use to differentiate asthma from vocal cord dysfunction?
Vocal cord dysfunction goes away at night.
How many apneas/hypopneas are needed to be pathologica (4 grades)
- normal: < 5/hour
- mild OSA: 5-15/hour
- moderate OSA: 15-30/hour
- severe OSA: >30/hour
What are some associations between OSA and the CV system?
- 1) arterial hypertension: stroke, LV dysfunction
- 2) pulmonary HT
- 3) arrhythmias
What are the 4 types of treatment for OSA?
- 1) Conservative (lose weight, positional therapy, alcohol avoidance)
- 2) CPAP
- 3) Mandibular advancement devices
- 4) Surgery
What are the symptoms of restless leg syndrome?
- the URGE symptoms:
- -intense Urge to move legs
- -symptoms worsen at Rest
- -relieved by Getting up
- -worse in the Evening
What is the difference between a nodule and a mass?
describe the 4 stages of lung cancer
- Stage I: 10-30% resection rate, 75% survival
- Stage II-III: confined to chest, a role for multimodal therapy
- Stage IV: palliative
Where are most lung cancers?
apical. mets are lower because of the increased blood flow
What would be a characteristic spirometry reading for someone with COPD?
- FEV1/FVC < 0.7 (post bronchodilator)
- decreased diffusion capacity
- FEV1 less than predicted
What are the 3 situations you would give oxygen for COPD?
- 1) PaO2 <= 55 mmHg AND SaO2 is <=87%: always give oxygen!
- 2) 55<= PaO2 <= 59 mmHg AND SaO2 is < 90%: if they have cor pulmonale and polycythemia, history of edema
- 3) PaO2 >59 AND SaO2 > 90%: desaturation during exercise, 20% improvement with O2, sleep dyspnea that CPAP doesn't help
etiologies of obstructive pulm disease
- cystic fibrosis/COPD
- Tracheal or broncheal obstruction
Treatment progression in asthma (5)
- 1) education, environment control, written action plan+fast acting bronchodilator
- 2) add inhaled corticosteroid or LTRA
- 3) add LABA
- 4) add LTRA of not already on it
- 5) systemic corticosteroids (prednisone)
Treatment for COPD (5)
- Prevention (smoking cessation, vaccines)
- Dilators (B2 agonist - salbutamol; anticholin - atrovent)
how do you differentiate emphysema from chronic bronchitis?
emphysema: pink puffer (pink skin and pursed lip breathing)
chronic bronchitis: blue bloater (cyanosis, fat, chronic purulent cough)
List causes of ILD that affect the upper lung lobes (4) and lower lung lobes (4)
Upper (FACTS, often end in 'sis): Farmer's lung (hypersens), Ankylosing spondylitis, Coal miners pneumoconiosis , TB, Sarcoidosis
Lower (CARS) : Cryptogenic Organizing Pneumonia, asbestosis, rheum diseases, scleroderma
What is a drug commonly implicated in causing ILD
Organize the following ILD's:
Coal Worker's pneumo
Usual Interstitial Pneumonia (aka IPF)
Desquam interstitial pneumonia
Lymphoid Interstitial pneumonia
Non-specific interstitial pneumonia
Pigeon Breeder's lung